From the Guidelines
The findings of a large left maxillary mucus retention cyst and hypoplastic frontal sinuses on a CT scan of the head typically do not require immediate treatment unless they are causing symptoms. Mucus retention cysts are common, benign findings that occur when a mucous gland becomes blocked, leading to fluid accumulation. For asymptomatic maxillary mucus retention cysts, observation is recommended with follow-up imaging in 6-12 months to monitor for changes in size, as suggested by the most recent study 1. If the cyst is causing symptoms such as facial pain, pressure, recurrent sinusitis, or nasal obstruction, treatment options include endoscopic sinus surgery to marsupialize or remove the cyst. Hypoplastic frontal sinuses are a normal anatomical variant where the frontal sinuses are underdeveloped; this requires no treatment and is simply noted for anatomical reference during any future procedures. Some key points to consider in the management of maxillary mucus retention cysts include:
- The presence of a mucous retention cyst can impact the natural ostium and block mucosal drainage, potentially causing inflammatory or infective conditions if the sinus membrane is elevated during maxillary sinus elevation, as noted in 1 and 2.
- Large cysts may need to be treated prior to sinus floor elevation by an otorhinolaryngologist, especially if they occupy a significant portion of the sinus volume, as discussed in 1.
- Symptomatic management may include saline nasal irrigation twice daily, intranasal corticosteroids like fluticasone (2 sprays in each nostril daily), and over-the-counter analgesics for pain if needed. These findings should be correlated with clinical symptoms, as many incidental sinus abnormalities on CT scans are not clinically significant and do not require intervention, a principle supported by various studies including 3, 4, and 5.
From the Research
Mucus Retention Cyst of the Maxillary Sinus
- A large left maxillary mucus retention cyst can be treated with endoscopic surgery, which has a low rate of recurrence and no complications 6.
- The endoscopic approach is recommended as the surgical procedure of choice for removing retention cysts from the maxillary sinus 6, 7.
- However, some studies suggest that symptomatic relief can be achieved with endoscopic ethmoidectomy and middle meatus antrostomy without cyst detachment, yielding similar outcomes to cyst extirpation 7.
- Mucosal cysts of the maxillary sinus are often asymptomatic and do not require surgical treatment, with a natural course characterized by a decrease in size or unchanged status in most cases 8.
Hypoplastic Frontal Sinuses
- Hypoplastic maxillary antrum is occasionally encountered in otorhinolaryngological practice and can present as a persistent maxillary sinusitis 9.
- Radiology plays a crucial role in diagnosis and management of sinusitis in the hypoplastic maxillary antrum, and anomalies of the lateral nasal wall must be recognized pre-operatively to avoid surgical damage to the orbit 9.
- A posteriorly placed middle meatal antrostomy is recommended as the surgical treatment of choice for hypoplastic maxillary antrum 9.
Diagnosis and Imaging
- Cone beam computed tomography (CBCT) scans can detect mucous retention cysts of the maxillary sinus more accurately than panoramic radiography 10.
- CBCT scans can confirm the presence of mucous retention cysts and measure their size, providing valuable information for diagnosis and treatment planning 10.